{
  "abstract": "A 61-year-old man was diagnosed with advanced-stage diffuse large B-cell lymphoma with systemic and cerebrospinal fluid (CSF) involvement. MR scans of the neuro-axis showed no central nervous system or nerve root abnormalities, but CSF testing identified lymphoma cells on cytology/flow cytometry, confirming nervous system involvement. After three out of six planned cycles of intrathecal methotrexate plus rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone, he had achieved a complete metabolic response by positron-emission tomography (PET) scan. Despite this transient apparent systemic response and before his final cycle, he developed a subacute, rapidly progressive, painful sensorimotor polyradiculoneuropathy with associated bilateral facial, left oculomotor neuropathies and neuromuscular respiratory weakness within a period of 3 weeks. He required intubation and mechanical ventilation and received intravenous immunoglobulin 2 g/kg over 5 days for an initial diagnosis of Guillain–Barré syndrome. Electromyography and nerve conduction studies showed bilateral facial neuropathies and a mixed axonal and demyelinating polyradiculoneuropathy. He had minimal improvement and an MR scan of the lumbosacral plexus identified right sciatic nerve enlargement, T2 hyperintensity and enhancement; a PET-CT showed mild ¹⁸F-fluorodeoxyglucose (FDG) uptake only at the sciatic nerves, right greater than left (figure 1). A targeted right sciatic fascicular nerve biopsy confirmed neurolymphomatosis (figure 2). This progressed (figure 1) despite escalation of treatment to high-dose intra-venous methotrexate, rituximab and temozolomide and he died within 1 month.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Felipe J S Jones"
    },
    {
      "affiliations": [
        "Department of Neurologic Surgery and Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Robert J Spinner"
    },
    {
      "affiliations": [
        "Peripheral Nerve Laboratory, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "JaNean Engelstad"
    },
    {
      "affiliations": [
        "Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Audrey M Blazek"
    },
    {
      "affiliations": [
        "Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Kimberly K Amrami"
    },
    {
      "affiliations": [
        "Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Marcus V Pinto"
    }
  ],
  "title": "Peripheral nerves can serve as a sanctuary for lymphoma",
  "uid": "de9136f0-bb74-5925-b3af-da86b38737fb"
}